Massachusetts Still a Leader in Health Coverage

September 13, 2011

MASSACHUSETTS STILL A LEADER IN HEALTH COVERAGE

Thanks to the apparent success of Massachusetts' health reform, Census Bureau estimates released today indicate that Massachusetts still leads the nation in health care coverage. The Massachusetts health insurance coverage rate is more than ten percentage points higher than the national rate.

(The Census Bureau recommends caution in citing these data for state-level analyses, and notes that these data are best for multi-year state comparisons, and for examining estimates of the insured and uninsured population at the national level. On September 22, the Census Bureau will release additional numbers that will offer more detailed state-level information that will allow for more accurate analyses of Massachusetts health care coverage.)

Using a multi-year average, the Census data estimate that in the 2008-2010 period, Massachusetts had a health insurance coverage rate of 95 percentmore than any other state in the nation. According to these data, only one out of every twenty Massachusetts residents is without health care coverage.1 The closest state to Massachusetts is Hawaii, with health insurance coverage of 92.5 percent. Texas, on the other hand, covered only 75.2 percent of its population during the 2008-2010 period, leaving close to one in four persons without health insurance coverage.

In 2010, the Census Bureau estimates that the percentage of uninsured16.3 percentis not statistically different from the rate in 2009. In 2010, 49.9 million people went without health insurance in the United States, an increase over the prior year's estimate of 49.0 million. (The total number of people without health insurance increased even though the percentage of people without health insurance did not show a statistically significant change due to an increase in the total population of the United States during this time.)

The impact of the recession can be seen, however, in a decline in the percentage of people receiving employer-based health care coverage. Nationally, the percentage of people who received their health care coverage from an employer in 2010 was 55.3 percent, down from 56.1 percent in 2009. The number of people covered by health insurance provided by an employer dropped from 170.8 million in 2009 to 169.3 million in 2010.

Health insurance coverage from public (government) insurance programs, on the other hand, increased to 31.0 percentup from 30.6 percent in 2009, an increase of close to 1.8 million people nationally.

Within the next few months, Congress will consider a plan to reduce the nation's budget deficit. A so-called "Supercommittee" comprised of 12 members of Congress has the task of proposing a deficit reduction plan of as much as $1.2 trillion in savings over the next ten years. If the Supercommittee decides to meet this target in part with cuts to the states' Medicaid programs or to Medicare, health care coverage for some portion of the close to 95 million people who rely on government-provided health insurance could be jeopardized. For states like Massachusetts, cuts to federal funding for the Medicaid program (jointly funded by state and local governments) would likely shift more of the costs of that program from the federal budget to state budgets. This would put significant pressure on the state's funding of essential services, and the Commonwealth's health care coverage rate could drop.

The Census Bureau data are from the Annual Social and Economic Supplements (ASEC) to the Current Population Survey (CPS). On September 22, the Census Bureau will release a second set of datathe American Community Survey (ACS). The ACS data will also include health insurance information, and this is the source the Census Bureau recommends using for detailed state-level analysis.2 Since the ACS has only included questions about health insurance coverage for three years, however, these data will not be useful for analyzing trends over longer periods of time. Census Bureau data are the only reliable sources for comparisons across states, and can be the best source for information about long-term trends. Nevertheless, measuring health insurance coverage is particularly tricky. The CPS asks respondents in the spring whether they were covered by health insurance at any time during the previous year. "Health insurance" for these purposes includes any type of private or publicly-funded health insurance plan, including health insurance provided by a place of employment, purchased individually, or provided by a government entity. People are counted as "insured" if they indicate that they had any type of coverage for part of all of the previous calendar year. With the release of the 2010 data, the Census Bureau introduces an improved methodology for the CPS health insurance data, which they indicate corrects for a tendency in these data to under-report the rate of health insurance, i.e., overstate uninsurance. They have also adjusted historical data for 1999 through 2009 to reflect this new methodology.

1Because of differences in methodology, there has been variation in the estimates of health insurance coverage in Massachusetts. The Massachusetts Division of Health Care Finance and Policy released data earlier this year estimating the state's health care coverage rate at more than 98 percent, suggesting that only approximately 120,000 Massachusetts residents remain without health care coverage. See "Health Care in Massachusetts: Key Indicators - May 2011 Edition" available at http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/11/2011_key_indicators_may.pdf.